fenoldopam

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fenoldopam

 [fe-nol´do-pam]
a vasodilator used for short-term, inpatient management of severe hypertension, administered intravenously as the mesylate salt.

fenoldopam

(fen-ole-doe-pam) ,

Corlopam

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: vasodilators
Pregnancy Category: B

Indications

Short-term (<48 hr), in-hospital management of hypertensive emergencies, including malignant hypertension with end-organ deterioration.

Action

Acts as an agonist at dopamine d1-like receptors.
Also binds to alpha-adrenergic receptors.
Acts as a vasodilator.

Therapeutic effects

Rapid lowering of BP.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Metabolism and Excretion: Mostly metabolized by the liver; 90% of metabolites are excreted in urine, 10% in feces.
Half-life: 5–10 min.

Time/action profile (effect on BP)

ROUTEONSETPEAKDURATION
IVrapid15 min1–4 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to fenoldopam or sulfites; Concurrent beta blocker therapy (will prevent reflex tachycardia).
Use Cautiously in: Glaucoma or intraocular hypertension; Obstetric / Pediatric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • headache (most frequent)
  • nervousness/anxiety
  • dizziness

Cardiovascular

  • hypotension (most frequent)
  • tachycardia (most frequent)
  • ECG changes
  • peripheral edema

Gastrointestinal

  • nausea (most frequent)
  • abdominal pain
  • constipation
  • diarrhea
  • vomiting

Dermatologic

  • flushing (most frequent)
  • sweating

Fluid and Electrolyte

  • hypokalemia

Local

  • injection site reactions

Musculoskeletal

  • back pain

Interactions

Drug-Drug interaction

Concurrent use with beta blockers may result in excessive hypotension (concurrent use should be avoided).

Route/Dosage

Intravenous (Adults) 0.01–1.6 mcg/kg/min.

Availability

Concentrate for injection: 10 mg/mL in 1– and 2-mL single-use ampules (with sodium meta-bisulfite)

Nursing implications

Nursing assessment

  • Monitor BP, heart rate, and ECG frequently throughout therapy; continuous monitoring is preferred. Consult physician for parameters.
  • Lab Test Considerations: Monitor serum potassium concentrations every 6 hr during therapy. May cause hypokalemia. Treat with oral or IV potassium supplementation.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)

Implementation

  • Intravenous Administration
  • pH: 2.8–3.8.
  • Administer via continuous infusion; do not use bolus doses. Avoid hypotension and rapid decreases in BP. Initial dose titration should occur no more frequently than every 15 min and less frequently as desired BP is reached. Increments of 0.05 to 0.1 mcg/kg/min are recommended for titration. Lower initial doses (0.03 to 0.1 mcg/kg/min) titrated slowly have been associated with less reflex tachycardia than higher initial doses.
    • Infusion can be abruptly discontinued or gradually tapered before discontinuation. Oral therapy with other antihypertensives can begin anytime after the BP is stable. Do not administer beta blockers concurrently with fenoldopam.
  • Continuous Infusion: Diluent: Dilute 4 mL (40 mg of drug) with 1000 mL, 2 mL (20 mg of drug) with 500 mL, or 1 mL (10 mg of drug) with 250 mL of 0.9% NaCl or D5W. Infusion is stable for 24 hr at room temperature. Concentration: 40 mcg/mL.
  • Rate: Based on patient's weight (see Route/Dosage section). Titrate to desired effect. Administer via infusion pump to ensure accurate dosage rate.
  • Y-Site Compatibility: alfentanil, amikacin, aminocaproic acid, amiodarone, ampicillin/sulbactam, argatroban, atracurium, atropine, azithromycin, aztreonam, butorphanol, calcium chloride, calcium gluconate, caspofungin, cefazolin, cefepime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, clindamycin, cyclosporine, daptomycin, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, dolasetron, dopamine, doxycycline, droperidol, enalaprilat, epinephrine, ertapenem, erythromycin, esmolol, famotidine, fentanyl, fluconazole, gentamicin, granisetron, haloperidol, heparin, hydralazine, hydrocortisone sodium succinate, hydromorphone, imipenem/cilastatin, insulin, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, meperidine, metoclopramide, metoprolol, metronidazole, micafungin, midazolam, milrinone, morphine, nafcillin, nalbuphine, naloxone, nicardipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, palonosetron, pancuronium, phenylephrine, piperacillin/tazobactam, potassium chloride, potassium phosphate, procainamide, promethazine, propofol, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sufentanil, tacrolimus, theophylline, ticarcillin/clavulanate, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, voriconazole
  • Y-Site Incompatibility: acyclovir, aminophylline, amphotericin B, ampicillin, bumetanide, cefoxitin, dexamethasone sodium phosphate, diazepam, fosphenytoin, furosemide, ganciclovir, ketorolac, meropenem, methohexital, methylprednisolone sodium succinate, pantoprazole, pentobarbital, phenytoin, prochlorperazine, sodium bicarbonate, thiopental

Patient/Family Teaching

  • Explain purpose of medication to patient.
  • Advise patient to report headache or pain at the injection site.

Evaluation/Desired Outcomes

  • Decrease in BP without the appearance of side effects.

fenoldopam

/fe·nol·do·pam/ (fe-nol´do-pam) a vasodilator used for short-term, inpatient management of severe hypertension; used as the mesylate salt.

fenoldopam

an antihypertensive.
indications It is used to treat hypertensive crisis when an urgent decrease of pressure is required, including malignant hypertension.
contraindications Known hypersensitivity to this drug and sulfite sensitivity prohibit its use.
adverse effects Life-threatening effects are hypotension, myocardial infarction, ischemic heart disease, and leukocytosis. Other adverse effects include anxiety, dizziness, ST-T wave changes, angina pectoris, palpitations, nausea, vomiting, constipation, diarrhea, bleeding, and increased levels of blood urea nitrogen, glucose, lactic dehydrogenase, creatinine, and hypokalemia. Headache is a common side effect.
References in periodicals archive ?
In 94% of the cases, the physician chose fenoldopam mesylate, a selective dopamine agonist that increases renal blood flow and glomerular filtration rates.
Tumlin's presentation, "Intra-Renal Infusion with Fenoldopam Mesylate Reduces Acute Kidney Injury Following Cardiothoracic Surgery or Exposure to Iodinated Contrast Agents: Results from the Be-RITe Registry," included the analysis of 501 patients enrolled in the Be-RITe Registry.
Tumlin reported that the intra-renal delivery of fenoldopam mesylate (a potent renal vasodilator) using the Benephit catheter allows for higher doses to be delivered directly to the renal vascular bed, significantly increasing glomerular filtration rates (measurement of kidney function), without the development of systemic hypotension (the lowering of blood pressure).
Physician-specified agents used for TRT within the procedures included fenoldopam mesylate (93.
Agents infused using TRT included: fenoldopam mesylate (92.
A sub-set analysis of the registry population was completed on 189 patients who had available SCr (serum creatinine) follow-up at 48 hours after the intra-renal infusion of fenoldopam mesylate during coronary or peripheral intervention and/or diagnostics.